Provider Demographics
NPI:1396361390
Name:DIX, KAI (MHC-LP)
Entity Type:Individual
Prefix:
First Name:KAI
Middle Name:
Last Name:DIX
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1268 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5241
Mailing Address - Country:US
Mailing Address - Phone:718-382-0045
Mailing Address - Fax:718-382-0051
Practice Address - Street 1:1268 E 14TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5241
Practice Address - Country:US
Practice Address - Phone:718-382-0045
Practice Address - Fax:718-382-0051
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP103609101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health